妇科腹腔镜改良开放穿刺法的随机对照研究

Randomized control study of modified open puncture method in gynecological laparoscopic surgery

目的:比较初学者使用第一枚Trocar直接穿刺和传统气腹针穿刺两种方法建立气腹的学习曲线和并发症发生率,探讨第一枚Trocar直接穿刺的安全性、有效性和实用性。方法:随机将2009年7月至2009年12月入院接受腹腔镜手术的100例患者分为A、B两组,A组用改良的开放穿刺法,即切开脐孔筋膜或切开脐孔,直接穿刺第一枚Trocar,B组用传统的气腹针穿刺法,气腹形成后穿刺Trocar,分析两种方法的并发症发生率和术者的学习曲线。结果:两组穿刺成功率差异无统计学意义(χ2=2.743,P=0.098),均无大血管和器官损伤。A组的手术时间和并发症发生率优于B组(P<0.05)。术者掌握A方法的学习曲线短于B方法。结论:用改良的开放穿刺法建立气腹有效、快捷、易学。培训初学者用此方法更安全。

Objective：To compare the learning curve and complication rate of direct first Trocar puncture with that of traditional pneumoperitoneum needle puncture method for establishment of pneumoperitoneum in laparoscopic surgery for beginners,and to explore the safety,effectiveness and practicality of direct first Trocar puncture.Methods：One hundred women scheduled to undergo laparoscopy from Jul.2009 to Dec.2009 were randomly assigned to an improved open puncture group（group A） or Veress needle group（group B） in order to compare the complication rate and learning curve of the two techniques.The umbilical fascia or umbilicus of group A was incised,and the first Trocar was directly punctured.The group B was punctured by traditional Veress needle,and Trocar was inserted after pneumoperitoneum establishment.Results：No significant difference between the two groups in success rate was observed（χ^2=2.743,P=0.098）.No major vessels and viscera injuries occurred during punctures.In group A,the interval of procedure was significantly shorter and rate of complications was significantly lower than those of group B respectively（P〈0.05）.The learning curve of A method was also shorter.Conclusions：Modified open establishment of pneumoperitoneum is an effective,fast,easy to learn method,and the application of this method is more secure in training course for beginners.